HomeMy WebLinkAboutHomestead_PrattCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
State Forrn5473 (R5/ 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. F
CERTIFICA110)tNATEMENT
AL
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I (we) certify,, at on the 1 StU di�&h. 20_
e
"potty Tax 7
Homeste d'i hereby claimed:
I (We) occupi9d as our principal place of residence the following described real property for which a a
❑ l(We)owned ❑ Are buying under contract
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Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is untder rf I
P-,CONTRACT!RECORDED.ft';,-�
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROP E RTY-_&WN ED BY CL AI MANT 114 _OTH ER-C 6 UNTIts
W_ PROPERTY. D E S C RI PT I 6N
County
Township
Taxing district (cif 1 � ship)
I 1
Parcel number
al scriptio
Is the property in question:
cos3a-cn
IS XE��
Real property ❑ Mobile Homo (I.C. 6-1.1-7)
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If any portion of the residential structure or the land not exceeding one (1) acre that imurnedialely surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROP E RTY-_&WN ED BY CL AI MANT 114 _OTH ER-C 6 UNTIts
�
1,
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
n I
�
'cress sIr star code..
IS XE��
Land not exceeding 1 (one) acre immediately
I
--------------
R XSA Ai
.TRUEJAX:;:
ASSESSED VALUE
�HOMESTEAR
;`N ON-RESIDENTIAL
I
W
,VALUE��
'AT100 6 TTV�
"YA�YE�
IS XE��
Land not exceeding 1 (one) acre immediately
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surrounding residential improvements-
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1f2 Homestead
Valuation or $6.000
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